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Re: VBAC policy, Opinions regarding actions taken by a practitioner, long.From: ainsron@msn.comMon Jan 24 10:13:08 2000
At Sat, 22 Jan 2000, K Dew wrote: > >As a result of ACOGs fairly recent statement concerning VBACs, a relatively >hot topic on the list recently, a hospital where I have privileges has >declared that VBACs are no longer allowed. We do not have an open operating >room 24 hours per day nor do we have full time, in house anesthesia or OR >crew. We have a basic blood bank with the nearest blood supply about 45 >minutes away. (all this is for background) > I have a general aversion to hospital administration telling physicians what procedures they can or can't perform, it should be a medical decision. I also have a problem with a medical executive committee, composed of non-obs deciding what is safe and unsafe based on a controversial ACOG practice guideline. I would venture to say that VBAC is still being practiced at many similar small hospitals in this country without in-house anesthesia. It certainly is in my hospital! If this physician is counselling his patients adequately and giving them informed consent regarding the risks of VBAC, specifically the risks of VBAC at the hospital in question, lack of in-house anesthesia, etc., then the administration should monitor closely and keep their hands off. Like others, I feel that IV access should be established in these patients when they are in active labor, but if an amniotomy was done to induce labor and IV access is established an hour or two later when she begins to have contractions, what's the problem? I've not heard of a uterus rupturing prior to labor. In my view, it is no different than the patient who has SROM at home and comes into the hospital later.
-- Ronald E. Ainsworth, MD
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